Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: Results from the International Radical Cystectomy Consortium (IRCC)

Ali Al-Daghmin, Eric C. Kauffman, Yi Shi, Ketan Badani, M. Derya Balbay, Erdem Canda, Prokar Dasgupta, Reza Ghavamian, Robert Grubb, Ashok Hemal, Jihad Kaouk, Adam S. Kibel, Thomas Maatman, Mani Menon, Alex Mottrie, Kenneth Nepple, John G. Pattaras, James O. Peabody, Vassilis Poulakis, Raj PruthiJuan Palou Redorta, Koon Ho Rha, Lee Richstone, Francis Schanne, Douglas S. Scherr, Stefan Siemer, Michael Stöckle, Eric M. Wallen, Alon Weizer, Peter Wiklund, Timothy Wilson, Gregory Wilding, Michael Woods, Khurshid A. Guru

Research output: Contribution to journalArticle

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Abstract

Objective To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer. Patients and Methods Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. Results In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386 min and 350†‰mL vs 396 min and 350 mL for p T4 and ≤pT3, respectively. The complication rate was similar (54% vs 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. Conclusions RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.

Original languageEnglish (US)
Pages (from-to)98-103
Number of pages6
JournalBJU International
Volume114
Issue number1
DOIs
StatePublished - 2014

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Cystectomy
Urinary Bladder Neoplasms
Mortality
Morbidity
Multivariate Analysis
Smoking
Demography
Databases

Keywords

  • bladder cancer
  • efficacy
  • IRCC
  • radical cystectomy
  • robot-assisted

ASJC Scopus subject areas

  • Urology

Cite this

Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer : Results from the International Radical Cystectomy Consortium (IRCC). / Al-Daghmin, Ali; Kauffman, Eric C.; Shi, Yi; Badani, Ketan; Balbay, M. Derya; Canda, Erdem; Dasgupta, Prokar; Ghavamian, Reza; Grubb, Robert; Hemal, Ashok; Kaouk, Jihad; Kibel, Adam S.; Maatman, Thomas; Menon, Mani; Mottrie, Alex; Nepple, Kenneth; Pattaras, John G.; Peabody, James O.; Poulakis, Vassilis; Pruthi, Raj; Palou Redorta, Juan; Rha, Koon Ho; Richstone, Lee; Schanne, Francis; Scherr, Douglas S.; Siemer, Stefan; Stöckle, Michael; Wallen, Eric M.; Weizer, Alon; Wiklund, Peter; Wilson, Timothy; Wilding, Gregory; Woods, Michael; Guru, Khurshid A.

In: BJU International, Vol. 114, No. 1, 2014, p. 98-103.

Research output: Contribution to journalArticle

Al-Daghmin, A, Kauffman, EC, Shi, Y, Badani, K, Balbay, MD, Canda, E, Dasgupta, P, Ghavamian, R, Grubb, R, Hemal, A, Kaouk, J, Kibel, AS, Maatman, T, Menon, M, Mottrie, A, Nepple, K, Pattaras, JG, Peabody, JO, Poulakis, V, Pruthi, R, Palou Redorta, J, Rha, KH, Richstone, L, Schanne, F, Scherr, DS, Siemer, S, Stöckle, M, Wallen, EM, Weizer, A, Wiklund, P, Wilson, T, Wilding, G, Woods, M & Guru, KA 2014, 'Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: Results from the International Radical Cystectomy Consortium (IRCC)', BJU International, vol. 114, no. 1, pp. 98-103. https://doi.org/10.1111/bju.12569
Al-Daghmin, Ali ; Kauffman, Eric C. ; Shi, Yi ; Badani, Ketan ; Balbay, M. Derya ; Canda, Erdem ; Dasgupta, Prokar ; Ghavamian, Reza ; Grubb, Robert ; Hemal, Ashok ; Kaouk, Jihad ; Kibel, Adam S. ; Maatman, Thomas ; Menon, Mani ; Mottrie, Alex ; Nepple, Kenneth ; Pattaras, John G. ; Peabody, James O. ; Poulakis, Vassilis ; Pruthi, Raj ; Palou Redorta, Juan ; Rha, Koon Ho ; Richstone, Lee ; Schanne, Francis ; Scherr, Douglas S. ; Siemer, Stefan ; Stöckle, Michael ; Wallen, Eric M. ; Weizer, Alon ; Wiklund, Peter ; Wilson, Timothy ; Wilding, Gregory ; Woods, Michael ; Guru, Khurshid A. / Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer : Results from the International Radical Cystectomy Consortium (IRCC). In: BJU International. 2014 ; Vol. 114, No. 1. pp. 98-103.
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abstract = "Objective To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer. Patients and Methods Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. Results In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386{\^a}€‰min and 350{\^a}€ ‰mL vs 396{\^a}€‰min and 350{\^a}€‰mL for p T4 and ≤pT3, respectively. The complication rate was similar (54{\%} vs 58{\%}; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4{\%} and 1.8{\%} vs 4.2{\%} and 8.5{\%} for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. Conclusions RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.",
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author = "Ali Al-Daghmin and Kauffman, {Eric C.} and Yi Shi and Ketan Badani and Balbay, {M. Derya} and Erdem Canda and Prokar Dasgupta and Reza Ghavamian and Robert Grubb and Ashok Hemal and Jihad Kaouk and Kibel, {Adam S.} and Thomas Maatman and Mani Menon and Alex Mottrie and Kenneth Nepple and Pattaras, {John G.} and Peabody, {James O.} and Vassilis Poulakis and Raj Pruthi and {Palou Redorta}, Juan and Rha, {Koon Ho} and Lee Richstone and Francis Schanne and Scherr, {Douglas S.} and Stefan Siemer and Michael St{\"o}ckle and Wallen, {Eric M.} and Alon Weizer and Peter Wiklund and Timothy Wilson and Gregory Wilding and Michael Woods and Guru, {Khurshid A.}",
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TY - JOUR

T1 - Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer

T2 - Results from the International Radical Cystectomy Consortium (IRCC)

AU - Al-Daghmin, Ali

AU - Kauffman, Eric C.

AU - Shi, Yi

AU - Badani, Ketan

AU - Balbay, M. Derya

AU - Canda, Erdem

AU - Dasgupta, Prokar

AU - Ghavamian, Reza

AU - Grubb, Robert

AU - Hemal, Ashok

AU - Kaouk, Jihad

AU - Kibel, Adam S.

AU - Maatman, Thomas

AU - Menon, Mani

AU - Mottrie, Alex

AU - Nepple, Kenneth

AU - Pattaras, John G.

AU - Peabody, James O.

AU - Poulakis, Vassilis

AU - Pruthi, Raj

AU - Palou Redorta, Juan

AU - Rha, Koon Ho

AU - Richstone, Lee

AU - Schanne, Francis

AU - Scherr, Douglas S.

AU - Siemer, Stefan

AU - Stöckle, Michael

AU - Wallen, Eric M.

AU - Weizer, Alon

AU - Wiklund, Peter

AU - Wilson, Timothy

AU - Wilding, Gregory

AU - Woods, Michael

AU - Guru, Khurshid A.

PY - 2014

Y1 - 2014

N2 - Objective To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer. Patients and Methods Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. Results In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386 min and 350†‰mL vs 396 min and 350 mL for p T4 and ≤pT3, respectively. The complication rate was similar (54% vs 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. Conclusions RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.

AB - Objective To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer. Patients and Methods Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. Results In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386 min and 350†‰mL vs 396 min and 350 mL for p T4 and ≤pT3, respectively. The complication rate was similar (54% vs 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. Conclusions RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.

KW - bladder cancer

KW - efficacy

KW - IRCC

KW - radical cystectomy

KW - robot-assisted

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